Back Pain

11 Nov 2017

However, this time can vary greatly as it depends on the nature of your back injury, the treatment plan that you develop with your physiotherapist, and how compliant you are with your treatment and lower back pain exercises.

Most commonly, NSLBP is caused by back muscle strain , back ligament sprain Other chronic back conditions such as degenerative disc disease may underly the acute conditions and predispose you to the acute pain. In these cases, normally positional stress or postural fatigue creates an accumulated microtrauma that overloads your lower back structures over an extended period of time to cause injury and back pain. When you run, your core muscles have to work hard to support your spine and lower back, while your core, hips, glutes, and hamstrings have to join forces to keep you stable.

The stronger your bones, the stronger your whole body—and the lower your chances of an injury that could cause back pain. Various uncommon bone disorders, tumours, infection and pressure from structures near to the spine occasionally cause low back pain (fewer than 1 in 100 cases of low back pain). This means that aside from addressing any immediate spinal misalignment that might cause back pain, chiropractic care can also help address, prevent and treat deeper dysfunctions in your body.

Below is a discussion of the potential causes of back pain, my recommendations for back pain treatment, and how you can alleviate this problem without putting any additional burden on your health. What’s more, hormonal changes in pregnancy can loosen the joints and the ligaments that attach your pelvic bones to your spine, which can make you feel less stable and cause pain when you walk, stand, sit for long periods, roll over in bed, get out of a low chair or the tub, bend, or lift things. Smoking reduces blood flow to the lower spine and causes the spinal discs to degenerate.

Usually, lower back pain gets better in a few days or weeks and often you don’t need to see your GP. See our section on symptoms above for some advice about when to seek medical help. Medical conditions which can cause back pain include a slipped disc - which can cause back pain and numbness and tingling, sciatica - which can cause pain, numbness tingling and weakness in the lower back, legs and feet and ankylosing spondylitis - a swelling of the joints in the spine. A multi-year multicenter study called the Spine Patient Outcomes Research Trial (SPORT) compared the most commonly used surgical and nonsurgical treatments for patients with the three most common diagnoses for which spine surgery is performed: intervertebral disc herniation, spinal stenosis, and degenerative spondylisthesis.

The use of lumbar supports in the form of wide elastic bands that can be tightened to provide support to the lower back and abdominal muscles to prevent low back pain remains controversial. However, infections can cause pain when they involve the vertebrae, a condition called osteomyelitis; the intervertebral discs, called discitis; or the sacroiliac joints connecting the lower spine to the pelvis, called sacroiliitis. In many cases, low back pain is associated with spondylosis, a term that refers to the general degeneration of the spine associated with normal wear and tear that occurs in the joints, discs, and bones of the spine as people get older.

The lower back where most back pain occurs includes the five vertebrae (referred to as L1-L5) in the lumbar region, which supports much of the weight of the upper body. Chronic back pain is defined as pain that persists for 12 weeks or longer, even after an initial injury or underlying cause of acute low back pain has been treated. The majority of acute low back pain is mechanical in nature, meaning that there is a disruption in the way the components of the back (the spine, muscle, intervertebral discs, and nerves) fit together and move.

The first type of surgery is primarily performed in older patients who suffer from conditions causing nerve irritation or nerve damage Fusion of bony segments is also referred to as a spinal fusion , and it is a procedure used to fuse together two or more bony fragments with the help of metalwork. There are several common other potential sources and causes of back pain- these include spinal disc herniation and degenerative disc disease or isthmic spondylolisthesis, osteoarthritis (degenerative joint disease) and lumbar spinal stenosis , trauma, cancer, infection, fractures, and inflammatory disease. In the United States , acute low back pain is the fifth most common reason for physician visits and causes 40% of missed days off work.

The anatomic classification of back pain follows the segments of the spine: neck pain (cervical), middle back pain (thoracic), lower back pain (lumbar) or coccydynia (tailbone or sacral pain) with the lumbar vertebrae area most common for pain. Don’t medically investigate back pain until it’s met at least three criteria: (1) it’s been bothering you for more than about 6 weeks; (2) it’s severe and/or not improving, or actually getting worse; and (3) there’s at least one other red flag” (age over 55 or under 20, painful to light tapping, fever/malaise, weight loss, slow urination, incontinence, groin numbness, a dragging toe, or symptoms in both legs like numbness and/or tingling and/or weakness). The most common causes of lower back pain are strain and problems with back structures.

Medical management includes patient education, medications to relieve pain and muscle spasms , cortisone injection around the spinal cord (epidural injection), physical therapy (heat, massage by a therapist, ultrasound , exercises, electrical stimulation), and rest (not strict bed rest but avoiding reinjury). Irritation of a spinal nerve in the low back (lumbar radiculopathy) causes pain that goes down the leg. Overdoing it at the gym or golf course is one of the most common causes of overextended muscles leading to low back pain.

There is a significant overlap of nerve supply to many of the discs, muscles, ligaments, and other spinal structures, and it can be difficult for the brain to accurately sense which is the cause of the pain. However, a study published in the journal Health Services Research, proved that initial treatment costs were 50% lower when patients were referred to physical therapy, rather than an advanced imaging referral at their primary care consultation. Although the use of TENS treatment was on the rise in people on Medicare, in 2012 CMS stopped reimbursing patients for TENS units for the treatment of chronic LBP TENS devices are still reimbursable for other uses, including acute LBP.

Nine out of ten people who seek medical treatment for their back do not find out the primary cause of their pain This is because there are many factors contributing to the likelihood of pain, such as physical activities, but this association is not equivalent to the causation of back pain. After the initial symptoms are treated, your doctor may show you some exercises designed to strengthen muscles that support the back. Back pain is extremely common and causes a significant number of work absences, with most people suffering back pain at some point in their lives.

Most back pain is caused by sprains, strains, being out of condition and posture problems rather than spinal damage or other health conditions. Consider exercises such as stretching, strengthening, aerobic, yoga, or Tai Chi in a group setting for all patients with low back pain and sciatica as the main component of non-invasive treatment. This is because the nicotine and other toxins from smoking can keep spinal discs from getting all the nutrients they need from the blood, making disc injury more likely.

Your doctor or a physiotherapist can recommend more specific exercises to help your back muscles get stronger. If this posture causes pain, you may have another condition such as a problem with a disc or bones in your back. Your doctor or physiotherapist can recommend more specific exercises to help your back muscles get stronger.

Once your pain has receded, incorporate a regular stretching routine and work to strengthen the muscles in your back to help maintain proper posture and alignment of the spine. Old and unsupportive mattresses can cause back pain by not properly supporting the spine and keeping it alignment while you sleep. If you inadvertently stretch the lower back too far with a strain (cough or sneeze) or movement (overreaching), the already weakened muscles have made the spine less stable and easily subjected to lower, upper, or even right side back pain.

The initial sneeze can cause pressure to build causing a painful sensation within the lower back muscles. Your provider will try to determine the cause of your back pain and whether it is likely to quickly get better with simple measures such as ice, mild painkillers, physical therapy, and proper exercises. This is because the lower back supports most of your body’s weight.

Changes in Posture Anxiety can cause people to change their behaviors and posture, including the way they sit, what they do when they sit, whether they slouch, and so on. Changes in posture - especially when combined with the muscle tension from anxiety - can cause the muscles to be in uncomfortable positions and ultimately lead to back pain. In severe cases, medical attention may be necessary, but if your pain is less severe, yoga may be able to help by strengthening the back, stretching it and improving circulation to the spine and nerves. While a single incident can cause sudden spinal injury, cases of nagging, ongoing back pain seem to be caused by a range of factors working in combination.

Some causes of back pain in young people include poor posture, inappropriate forms of exercise and carrying heavy schoolbags. Some of the causes of back pain in young people include poor posture, lack of exercise and carrying heavy schoolbags. Patients who perceive that they have received an adequate explanation for the cause of their problem are less likely to want additional diagnostic tests and more likely to be satisfied with the visit than those who do not think they have been given an adequate explanation 79 In one randomized trial, low-risk patients who received an educational intervention rather than a plain radiograph were equally satisfied with their care and had equally good clinical outcomes 80.

Risk assessment chronic back pain — Patients who present initially with low back pain >12 weeks duration should undergo the risk assessment for acute and subacute back pain. ●Advanced imaging - MRI without contrast is generally considered the best initial exam for most patients with low back pain who require advanced imaging 65,66 It provides axial as well as sagittal views which can demonstrate normal and pathologic discs, ligaments, nerve roots, epidural fat, as well as the shape and size of the spinal canal. Disc herniations on MRI are seen in 22 to 67 percent of asymptomatic adults and spinal stenosis in 21 percent of asymptomatic adults over age 60 47-49 Evidence of osteoarthritis is often seen on imaging but correlates poorly with symptoms 50 In a community-based study of 188 individuals 40 to 80 years old, 60 percent of males and 67 percent of females had facet joint osteoarthritic changes on lumbar CT scans; radiologic facet joint osteoarthritis increased with age and there was no correlation with low back pain 51 (See “Acute lumbosacral radiculopathy: Pathophysiology, clinical features, and diagnosis”, section on ‘Neuroimaging’ and “Lumbar spinal stenosis: Pathophysiology, clinical features, and diagnosis”, section on ‘Neuroimaging’)

A 2009 systematic review and meta-analysis of six trials that compared immediate imaging (magnetic resonance imaging MRI, computed tomography CT, or radiography) with usual care for patients with acute and subacute low back pain, without signs or symptoms of infection or malignancy, found no significant differences in short-term (up to three months) or long-term (6 to 12 months) outcomes for measures of patient pain or function 45 A subsequent prospective observational study in patients ≥65 years with back pain but without radiculopathy found no differences in disability at one year for patients who received early imaging (within six weeks of the index visit) compared with those who did not 46. Damage to a spinal nerve root may result from degenerative changes in the vertebrae, disc protrusion, and other causes. Jakobson Ramin interviewed scores of spine surgeons, pain management doctors, physical medicine and rehabilitation physicians, exercise physiologists, physical therapists, chiropractors, and specialized bodywork practitioners.

Since 2003, the Healthy Back Institute has helped millions of people from around the world to get lasting relief from lower back pain , neck pain and sciatica. In a new study, researchers used magnetic resonance imaging (MRI) scans to observe the spines of six NASA astronauts before they landed, at the time of landing and about two months after they had spent upward of seven months on the International Space Station The researchers found that the prolonged exposure to weightlessness weakened the muscles supporting the astronauts’ spines. Try plank, superman, or bird dog exercises, which engage your erector spinae, the muscle that keeps your spine erect and helps maintain correct posture, he says.

“Your muscles get used to being in that seated position, so they tighten up.” To combat sitting-induced muscle stiffness and tightness, stretch your lower posterior muscles (Achilles, calves, hamstrings, and glutes) when you wake up. “When those start to tighten then your lower back starts to feel the brunt of the pain,” says Suggs. Usually, Xrays are ordered by your physician in cases in which he or she suspects congenital defects, degenerative disease, trauma, metastatic cancer or bone deformity as a cause of lower back pain. Exercises for the back strengthen and stretch muscles that support your back and legs and promote good posture.

 

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